The story of living in spite of melanoma, metastasis, vaccines, anti-PD-1, lung removal, and stereotactic radiation. The story of life with family and friends. {Posts under ~ Sew Chaotically, Travel Chaotically, and Chaotic Cookery also housed within! A girl's gotta have fun!}

About Me

Who am I? That is a question the rest of you could probably answer better than I. I am a wife, mother, daughter, sister, friend, pediatric nurse practitioner, cook, teacher, gardener, lover of words and music, occasional seamstress, and homemaker. I do have a couple of talents of questionable merit: I can create a decent meal in less than 30 minutes. I can feed and/or soothe almost any baby. And I can remember practically any song I've ever heard. For the rest, I'd rather those who know me decide.

High dose interleukin-2 (HD
IL-2) can induce durable responses in a subset of patients leading to long-term
survival. Immune checkpoint blockade (ICB) has demonstrated similarly durable
responses in a larger proportion of patients. However, not all patients respond
to immune checkpoint blockade and subsequent therapeutic options need to be
explored. The PROCLAIM database was
queried for patients with metastatic melanoma who had received HD IL-2 after
treatment with ipilimumab or without prior ICB. Patient characteristics, toxicity
and efficacy were analyzed. A total of 52 metastatic
melanoma patients were treated with high dose IL-2 after ipilimumab and 276
patients were treated with high dose IL-2 without prior ICB. The overall
response rate in the prior ipilimumab group was 21 % as compared to
12 % in the group that had not received prior ipilimumab. The median
overall survival, measured from the initiation of HD IL-2 therapy, was
19.3 months in the prior ipilimumab group and 19.4 months in the no
prior ICB group. Toxicities observed on HD IL-2 were relatively equivalent
between the groups although there were cases of CTLA4 antibody-induced colitis
reported after HD IL-2 treatment and a CTLA4 antibody-induced colitis related
death. In this retrospective
analysis HD IL-2 therapy displayed antitumor activity in melanoma patients who
progressed following treatment with ipilimumab. Most HD IL-2 toxicity was not
worsened by prior ipilimumab therapy except for one treatment related death
from colitis. Care should be taken to avoid reactivation of CTLA4
antibody-induced colitis.

Interleukin-2 (IL-2), initially used
in 1986, can induce clinical regression-complete responses (CR) and partial
responses (PR) of metastatic malignant melanoma. IL-2 has been used alone or in
combination, and in different dosage schedules, as an immunotherapeutic agent
for melanoma treatment. This meta-analysis
aimed to document and evaluate the spectrum of reported clinical response rates
from the combined experience of almost
30 years of IL-2 clinical usage. Clinical trials using IL-2 for metastatic
melanoma therapy that reported: dosage, combinations, study details,
definitions and clinical CR, PR, and overall response (OR) rates were included.
A meta-analysis was conducted using the preferred reporting items for
systematic reviews and meta-analyses (PRISMA) guidelines. In total, 34 studies
met inclusion criteria, with 41 separate treatment arms. For all IL-2 treatment
modalities collectively, the CR rate was
4.0%, PR 12.5%, and OR 19.7%. CR
pre-1994 was 2.7% versus 6.1% post-1994. High and intermediate-IL-2 dosage
showed no CR difference, while low-dose
IL-2 showed a nonstatistical trend toward an increased CR rate. The highest
CR rate resulted from IL-2 combined with vaccine at 5.0%. The meta-analysis
showed that IL-2 immunotherapy for advanced metastatic melanoma delivered a CR
rate of 4% (range, 0-23%) across nearly 30 years of clinical studies, with
gradual improvement over time. The significance is that, contrary to popular
belief, the data demonstrated that CR rates were similar for intermediate
versus high-IL-2 dosing.